The incidence of tuberculosis in the inflammatory bowel disease registry in Cape Town, South Africa

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dc.contributor.advisorThomson, Sandie
dc.contributor.advisorEpstein, David
dc.contributor.authorPema, Mitesh Kanthi
dc.date.accessioned2022-01-18T09:12:46Z
dc.date.available2022-01-18T09:12:46Z
dc.date.issued2021
dc.date.updated2022-01-12T11:50:03Z
dc.description.abstractBackground/Objectives: The risk of tuberculosis (TB) in inflammatory bowel disease (IBD) patients using immunosuppressive therapy (IST) is higher than the background population in developed countries. Corresponding data in areas of high endemicity like South Africa (SA) is limited. Our objectives were to calculate the incidence, identify predictors and determine clinical characteristics of TB common to IBD patients living in this environment. Methods: In this retrospective study, patients that developed active TB after their IBD diagnosis between 1948 and 2017 were selected from the SA IBD Registry. Incidence rates were calculated for the study population and for cases prescribed TNF-a (tumour necrosis factor-alpha) blockers. A multivariable logistic regression model, using non-TB IBD patients as controls, was applied to determine risk factors for infection. We analysed IBD and TB clinical features as well as screening tests for latent TB (LTB). Results: 42 TB cases (4%) out of 1041 consented IBD patients were identified. Incidence rates (IRs) for active infection per 100 000 person years (PY) of follow-up were 330 and 2749, for the cohort and TNF-a blocker users respectively. Patients with Crohn's disease (CD) (adjusted Odds Ratio (aOR) = 2.00, 95% confidence interval (CI): 0.92- 4.36), a smoking history (aOR = 1.44, 95% CI: 0.66-3.14), attendance at public hospitals (aOR = 1.81, 95% CI: 0.75-4.37) and a history of TNF-a blocker use (aOR = 2.45, 95% CI: 0.88- 6.80) were at greater risk for infection, although none were statistically significant. The median time to TB diagnosis was 96.7 months (interquartile range (IQR): 42.2-164.8) for the cohort and 11.3 months (IQR: 8.1-29.2) for biologics users. Over half the TB cases occurred in patients that live in districts with predominantly low-income households. The lung was the most common site affected. Latent TB infection (LTBI) occurred in twenty-four patients that were prescribed IST. Ten received isoniazid prophylaxis therapy (IPT) and one later developed active TB. Conclusion: TB is a significant problem in our IBD population. The establishment of local guidelines is recommended to assist clinicians with risk stratification and management of latent and active disease, especially in patients being considered for TNF-a blockers.
dc.identifier.apacitationPema, M. K. (2021). <i>The incidence of tuberculosis in the inflammatory bowel disease registry in Cape Town, South Africa</i>. (). ,Faculty of Health Sciences ,Department of Medicine. Retrieved from http://hdl.handle.net/11427/35507en_ZA
dc.identifier.chicagocitationPema, Mitesh Kanthi. <i>"The incidence of tuberculosis in the inflammatory bowel disease registry in Cape Town, South Africa."</i> ., ,Faculty of Health Sciences ,Department of Medicine, 2021. http://hdl.handle.net/11427/35507en_ZA
dc.identifier.citationPema, M.K. 2021. The incidence of tuberculosis in the inflammatory bowel disease registry in Cape Town, South Africa. . ,Faculty of Health Sciences ,Department of Medicine. http://hdl.handle.net/11427/35507en_ZA
dc.identifier.ris TY - Master Thesis AU - Pema, Mitesh Kanthi AB - Background/Objectives: The risk of tuberculosis (TB) in inflammatory bowel disease (IBD) patients using immunosuppressive therapy (IST) is higher than the background population in developed countries. Corresponding data in areas of high endemicity like South Africa (SA) is limited. Our objectives were to calculate the incidence, identify predictors and determine clinical characteristics of TB common to IBD patients living in this environment. Methods: In this retrospective study, patients that developed active TB after their IBD diagnosis between 1948 and 2017 were selected from the SA IBD Registry. Incidence rates were calculated for the study population and for cases prescribed TNF-a (tumour necrosis factor-alpha) blockers. A multivariable logistic regression model, using non-TB IBD patients as controls, was applied to determine risk factors for infection. We analysed IBD and TB clinical features as well as screening tests for latent TB (LTB). Results: 42 TB cases (4%) out of 1041 consented IBD patients were identified. Incidence rates (IRs) for active infection per 100 000 person years (PY) of follow-up were 330 and 2749, for the cohort and TNF-a blocker users respectively. Patients with Crohn's disease (CD) (adjusted Odds Ratio (aOR) = 2.00, 95% confidence interval (CI): 0.92- 4.36), a smoking history (aOR = 1.44, 95% CI: 0.66-3.14), attendance at public hospitals (aOR = 1.81, 95% CI: 0.75-4.37) and a history of TNF-a blocker use (aOR = 2.45, 95% CI: 0.88- 6.80) were at greater risk for infection, although none were statistically significant. The median time to TB diagnosis was 96.7 months (interquartile range (IQR): 42.2-164.8) for the cohort and 11.3 months (IQR: 8.1-29.2) for biologics users. Over half the TB cases occurred in patients that live in districts with predominantly low-income households. The lung was the most common site affected. Latent TB infection (LTBI) occurred in twenty-four patients that were prescribed IST. Ten received isoniazid prophylaxis therapy (IPT) and one later developed active TB. Conclusion: TB is a significant problem in our IBD population. The establishment of local guidelines is recommended to assist clinicians with risk stratification and management of latent and active disease, especially in patients being considered for TNF-a blockers. DA - 2021_ DB - OpenUCT DP - University of Cape Town KW - Medicine LK - https://open.uct.ac.za PY - 2021 T1 - The incidence of tuberculosis in the inflammatory bowel disease registry in Cape Town, South Africa TI - The incidence of tuberculosis in the inflammatory bowel disease registry in Cape Town, South Africa UR - http://hdl.handle.net/11427/35507 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/35507
dc.identifier.vancouvercitationPema MK. The incidence of tuberculosis in the inflammatory bowel disease registry in Cape Town, South Africa. []. ,Faculty of Health Sciences ,Department of Medicine, 2021 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/35507en_ZA
dc.language.rfc3066eng
dc.publisher.departmentDepartment of Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.subjectMedicine
dc.titleThe incidence of tuberculosis in the inflammatory bowel disease registry in Cape Town, South Africa
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMMed
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